Patient Information

Each patient of KCHC is required to bring the following information to each appointment

  • Driver’s License or State ID
  • Health Insurance Card (if you do not have insurance bring 30 days proof of total household income to apply for Sliding Fee Scale)
  • List of current medication, dosage and how many times a day you take the medication
  • Personal health history
    • Current and past health issues and treatments
    • Any recent discharge paperwork from Urgent Care or Emergency Room visits
    • Immunization records
    • Medical records and/or test results
  • Family health history
    • Any health issues that run in your family


  • Keeping your appointment with KCHC is very important. It can take a while to get in with your provider. If you are unable to keep your scheduled appointment, please contact us as soon as possible at 309-344-2225 to reschedule.
  • Individuals who chronically no-show for appointments will be offered limited appointment times and/or may be dismissed from the KCHC as a patient.

New Patient Forms

  • Family form
  • Single